甲状腺乳头状癌患者血清促甲状腺激素水平和组织促甲状腺激素受体检测的临床应用价值

目的　探讨血清中促甲状腺激素（ thyroid stimulating hormone，TSH）和甲状腺组织中促甲状腺激素受体（thyroid stimulating hormone recepter,TSHR）在甲状腺乳头状癌（ papillary thyroid carcinoma,PTC）中的应用价值。方法　收集甲状腺乳头状癌标本 55例，结节性甲状腺肿标本 32例，采用化学发光法检测血清中 TSH和免疫组化法检测甲状腺组织中 TSHR的表达。结果　PTC中血清 TSH水平明显高于结节性甲状腺肿，差异具有统计学意义（ χ2=-2.163，P<0.05）；且 PTC中，Ⅲ /Ⅳ期患者的血清 TSH水平明显高于Ⅰ /Ⅱ期，差异具有统计学意义（ χ2=-2.037， P<0.05）；血清 TSH的水平与患者年龄、性别、淋巴结转移与否和肿瘤大小，差异均无统计学意义（ Z=-0.024~-1.262,均 P >0.05）。TSHR在 PTC中的表达阳性率明显低于结节性甲状腺肿，差异具有统计学意义（ χ2=4.845，P<0.05）;PTC中， Ⅰ /Ⅱ期的表达阳性率高于Ⅲ /Ⅳ期，淋巴结未转移组的表达阳性率明显高于淋巴结转移组，差异具有统计学意义（Z=-3.097，-2.423，均 P <0.05）;TSHR的表达与患者年龄、性别和肿瘤大小，差异均无统计学意义（ Z=-0.846~-1.73，均 P >0.05）。结论　血清 TSH水平与 PTC发病和 TNM分期有关； TSHR的表达与 PTC发病、 TNM分期和淋巴结转移与否有关，两者可以作为 PTC诊断和预后判断的一项参考指标。

Clinical Application Value of Serum Thyrotropin Level and Tissue Thyrotropin Receptor Detection in Patients with Thyroid Papillary Carcinoma

Objective To investigate the application value of serum thyroid stimulating hormone(TSH)and thyroid tissue thyroid stimulating hormone recepter(TSHR)in papillary thyroid carcinoma(PTC).Methods 55 cases of papillary thyroid carcinoma and 32 cases of nodular goiter were collected.TSH in serum was detected by chemiluminescence method and TSHR expression in thyroid tissue was detected by immunohistochemistry.Results The serum TSH level in PTC was significantly higher than that in nodular goiter,and the difference was statistically significant(χ^2=-2.163,P<0.05).The level of serum TSH in phaseⅢ/Ⅳwas significantly higher than that in phaseⅠ/Ⅱ,and the difference was statistically significant(χ^2=-2.037,P<0.05).There was no significant difference in serum TSH level with age,gender,lymph node metastasis or tumor size(Z=-0.024~1.262,all P>0.05).The positive rate of TSHR in PTC was significantly lower than that in nodular goiter,and the difference was statistically significant(χ^2=4.845,P<0.05).The positive rate ofⅠ/Ⅱphase in PTC was significantly higher than that inⅢ/Ⅳphase,and the difference was statistically significant(Z=-3.097,P<0.05).The expression of TSHR in the non-lymphatic metastasis group was significantly higher than that in the lymphatic metastasis group,and the difference was statistically significant(Z=-2.423,P<0.05).The expression of TSHR had no significant relationship with age,sex and tumor size(Z=-0.846~-1.73,P>0.05).Conclusion Serum TSH level was related to PTC morbidity and TNM staging,the expression of TSHR was related to PTC morbidity,TNM staging and lymphatic metastasis.Both of them can be used as a reference index for PTC diagnosis and prognosis.